Periareolar mammaplasty for the treatment of gynecomastia with breast ptosis

Abstract

Gynecomastia, or enlargement of the male breast, may lead to serious psychological disturbances. The most common patient complaint is his embarrassment of his body image. Simon et al. [1], in 1973, described a clinical classifi-cation after analysis of 77 cases of gynecomastia: Grade 1, small, visible breast enlargement without skin redundancy; Grade 2A, moderate breast enlargement without skin redundancy; Grade 2B, moderate enlargement with skin redundancy; Grade 3, marked breast enlargement with marked skin redundancy. The first description of a surgical treatment was made by Paulus of Aegina [2] (AD 635-690) using a semilunar inframammary incision. Dufourmental [3], in 1928, described an infra-areolar marginal incision, divulged by Webster [4], in 1946. The transareolar mammary incision was published by Pitanguy [5], in 1966. Many surgical difficulties are found in Group 2B and 3, where excess skin is present. Some authors describe excess skin resection using a "half-moon" located at the borders of areola [6], others utilize vertical [7, 8], transverse [2], or oblique [9] skin ellipses. Free graft [10], as well as superior pedicle [7] and bipedicle flaps [2], is employed to elevate the nipple-areola complex in large gynecomastia. Joseph [11], in 1925, published a method of female mammaplasty, in two stages, where the nipple-areola complex is transplanted by means of an inferior pedicle flap. Andrews et al. [12], in 1975, described a periareolar approach for breast reduction. Ribeiro [13], in 1975, used an inferior pedicle flap with the aim of projecting the mammary cone and stabilizing its shape. Davidson [14], in 1979, removed excess skin in concentric circles, limiting the final scar to a circle at the perip-hery of the areola. Benelli [15], in 1988, presented a permanent periareolar circling to avoid late widening of the nipple-areola complex. Martins [16], in 1991, described a periareolar mammaplasty with flap transposition. Kornstein and Cinelli [17], in 1992, reported an inferior pedicle flap associated with a superiorly based chest wall flap to reposition the nipple-areola complex, resulting in a periareolar and inframammary scar. The authors reported in 1993 [18] the use of the periareolar mammaplasty, with an inferior pedicle flap including the nipple-areola complex, to correct a male breast ptosis. The aim of the present work is to evaluate the use of the periareolar skin approach associated with inferior or superior pedicle flaps that include the nipple-areola complex. © 2009 Springer-Verlag Berlin Heidelberg.